Theses (MSc. Public Health)

Objectives: This dissertation studied the time trends and distribution of fatal and non-fatal childhood drowning in Malaysia by demographic and spatial factors between 2000 and 2022. The difference in annual incidence between 2000-2011 and 2012-2022 was also identified. Methods: The drowning data reported to the national Health Informatics Centre (HIC) for 18 years old and below, from hospitalised cases of child drowning incidents and drowning deaths, were analysed. Data from the Department of Statistics Malaysia (DOSM) were also retrieved. These data were then used to calculate annual incidence, annual rates of change in drowning, and case fatality rates. Also, binary logistic regression analyses identified the socio-demographic and spatial factors associated with drowning. The outcome or the dependent variables were fatal and non-fatal, while age, year, sex, race, and region acted as independent variables. Results: A total of 4,191 reports of childhood drowning incidents and 155 drowning fatalities were reported to HIC. Drowning incidence rate was higher in 2000-2011 (IR 21.83) than in 2012-2022 (IR 17.65). Drowning incidence were significantly higher among the aged 0-4 years, boys, Bumiputera, and children living in urban areas (p<0.001). In contrast, the case fatality rate was higher in 2012-2022 (CFR 4.88) than in 2000-2011 (CFR 2.75). Children aged 0-9 years (p<0.001), children living in the Klang Valley region (p=0.049), and urban areas (p=0.034) were significant in fatal drowning. The time trends analysis for annual rates of change increased by 0.0001 for drowning incidents and 0.0003 for drowning fatalities. The east coast region significantly demonstrates 2.19 times (95% CI 1.03-4.65) higher than other regions (p=0.0041). Conclusions: This study provided more detail analyses of available childhood drowning data. The null hypothesis was rejected as there was a difference of drowning incidents in 2000-2011 and 2012-2022. The findings also suggested that preventive measures should be targeted towards children aged 0-9 years, boys, and children living in urban areas.

Introduction: The high burden of paediatric pneumonia warrants investigation on its occurrence and risk factors, particularly among children aged five years old and below. Objectives: To determine the a) risk factors associated with paediatric pneumonia, b) occurrence of PCR positivity, c) sensitivity and specificity of pneumococcal urinary antigen test (UAT) in detecting pneumococcal pneumonia and d) colonisers among children aged five years and below in east-coast of Peninsular Malaysia. Methods: This case-control study was conducted over two years at the east-coast of Peninsular Malaysia. Cases were hospitalised children ≤5 years old with clinical and radiological diagnosis by sentinel site paediatrician while controls were children without any features suggestive of pneumonia. Nasopharyngeal swab for polymerase chain reaction (PCR) and urine samples for pneumococcal UAT were collected within 24 hours of admission. Results: Six hundred children, with mean age of 20.99 ± 15.35 months for cases and 21.57 ± 16.96 months for controls, were included in the study. Regression analysis revealed factors associated with pneumococcal pneumonia are children living in household of 3-5 occupants (OR, 1.821; 95%, CI 1.191-2.787, p=0.006), unknown history of hospitalisation (OR, 1.672; 95%, CI 1.034-2.703, p=0.036), and underaged children for vaccination up-to-age (UTA) (OR, 1.552; 95%, CI 1.013-2.378, p=0.044) were found to be significant factors among subjects. PCR testing revealed a positivity rate of 13.5% (n=81) among cases and 5.2% (n=31) among controls, accounting 18.7% (n=112) of all subjects. Additionally, UAT testing showed positivity rate of 8.7% (n=52) cases and 6.8% (n=41) controls, comprising 15.5% (n=93) of the subjects. The sensitivity and specificity of UAT were 38.4% and 89.8% respectively with positive predictive value (PPV) of 46.2% and negative predictive value (NPV) of 86.4%. UAT sensitivity and specificity among cases were 37% and 90% respectively while PPV of 57.7% and NPV of 79.4%. UAT sensitivity and specificity among controls were 41.9% and 89.6% respectively while PPV of 31.7% and NPV of 93.1%. Conclusion: Emphasise on risk factor prevention should be the preference over clinical management. Surveillance on local aetiology is essential. UAT was found to be an unsuitable rapid tool in diagnosing pneumococcal pneumonia nor detecting colonisers in paediatrics. Thus, research focus on higher valency vaccines production and invention of simpler, rapid, and non-invasive diagnostic method to reduce disease burden and improve disease prognosis.